China special issue on gastrointestinal tumors-Improved survival after multidisciplinary team decision for patients with advanced gastrointestinal cancer: A multicenter,noninterventional, controlled study

Formal multidisciplinary team (MDT) discussions in clinical practice require time and space but have unclear survival benefits for advanced gastrointestinal cancer patients. Our study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after MDT decision. From June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in 13 medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in the MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. A total of 461 MDT decisions of 455 patients were included in our study. The implementation rate of MDT decisions was 85.7%. Previous treatment had an impact on MDT decision-making. The OS was 24.0 months and 17.0 months in the implementation and nonimplementation groups, respectively. The implementation of MDT decisions significantly reduced the risk of death in multivariate analyses (hazard ratio = 0.518; 95% confidence interval: 0.304-0.884, P = .016). Subgroup analysis showed a significant difference in survival of patients with colorectal cancer, but not in survival of patients with gastric cancer. The rate of secondary MDT discussion was only 5.6% among patients who the MDT decisions were discontinued due to changes in their condition. MDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially those with colorectal cancer. Timely scheduling of the subsequent MDT discussion is necessary when the disease condition changes.     

阿魏酸脂质体的体外释放度考察

目的:通过优化处方和工艺制备缓释、长效的阿魏酸脂质体植入制剂。方法:采用HPLC测定阿魏酸含量,流动相乙腈-0.1%磷酸(22∶78),检测波长324 nm。运用醋酸钙主动载药技术制备阿魏酸脂质体,使用透析法考察阿魏酸脂质体的释放度。通过单因素试验考察磷脂材料、胆固醇含量、粒径及不同血液成分对阿魏酸脂质体释放度的影响,利用温敏凝胶技术进一步延长阿魏酸脂质体的缓释效果。结果:阿魏酸脂质体选择氢化大豆磷脂(HSPC)为脂质体膜材,HSPC与胆固醇的摩尔比4∶1,超声时间1 min,脂质体平均粒径397.7 nm,可实现12 h缓释效果,血液成分能够加速脂质体的释放但不同血液成分无显著性差异。采用温敏凝胶技术可延长阿魏酸脂质体的缓释效果,体外释药符合Higuchi方程且持续释放时间48 h。结论:胎牛血清和大鼠血浆可替代人血清用于阿魏酸脂质体的释放度考察。通过控制脂质体的处方与工艺因素,并结合温敏凝胶技术可实现阿魏酸脂质体的缓释、长效。     

The prospective evaluation of viral loads in patients with severe fever with thrombocytopenia syndrome

BackgroundSevere fever with thrombocytopenia syndrome (SFTS), caused by novel bunyavirus (SFTSV) is a potentially fatal disease that was first identified in China. Person to person transmission through contact with blood or body fluids was considered as an important infection route.ObjectivesThe study is designed to investigate the longitudinal viral loads following SFTSV infection and to identify factors affecting viral shedding in SFTS patients.MethodsA prospective, observational study was performed on 208 laboratory-confirmed SFTSV infected patients in Xinyang, Henan Province. Sequential serum samples were collected on admission and during the hospitalization for quantification of SFTSV RNA by real-time RT-PCR.ResultsThe viral RNA was undetectable in 55.6% of the patients on admission into the hospital, becoming detectable in most cases until three days and attained maximum level on six days after disease onset. This was followed by an obvious decrease thereafter, but maintained detectable for over 20 days. Viral load was independently predictable of severe disease outcome throughout the hospitalization. Viral load of >10⁷ copies/mL was predictable of fatal outcome. The serum levels of PLT, WBC, LDH, AST and CK were significantly associated with viral loads level.ConclusionsThe diagnosis of SFTSV infection based on PCR test should be performed at least three days after disease onset. Peaking viral loads were attained around six days after disease, posing a highest risk of human-to-human transmission.